Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal

Abstract

Aim Although carbapenem is the last-resort drug for treating drug-resistant Gram-negative bacterial infections, prevalence of carbapenem-resistant bacteria has substantially increased worldwide owing to irrational use of antibiotics particularly in developing countries like Nepal. Therefore, this study was aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to detect the carbapenemase genes (blaNDM-2 and blaOXA-48) in at a tertiary care hospital in Nepal. Materials and methods A hospital-based cross-sectional study was carried out from June 2018 to January 2019 at the Microbiology Laboratory of Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal. Different clinical samples were collected and cultured in appropriate growth media. Biochemical tests were performed for the identification of K. pneumoniae. Antibiotic susceptibility testing (AST) was performed by the Kirby–Bauer disc diffusion method. The modified Hodge test (MHT) was performed to detect carbapenemase producers. The plasmid was extracted by the modified alkaline hydrolysis method. Carbapenemase-producing K. pneumoniae were further confirmed by detecting blaNDM-2 and blaOXA-48 genes by PCR using specific forward and reverse primers followed by gel electrophoresis. Results Out of the total 720 samples, 38.9% (280/720) were culture positive. K. pneumoniae was the most predominant isolate 31.4% (88/280). Of 88 K. pneumoniae isolates, 56.8% (50/88) were multi-drug resistant (MDR), and 51.1% (45/88) were MHT positive. Colistin showed the highest sensitivity (100%; 88/88), followed by tigecycline (86.4%; 76/88). blaNDM-2 and blaOXA-48 genes were detected in 24.4% (11/45) and 15.5% (7/45) of carbapenemase-producing K. pneumoniae isolates, respectively. Conclusion The rate of MDR and carbapenemase production was high in the K. pneumoniae isolates. Colistin and tigecycline could be the drug of choice for the empirical treatments of MDR and carbapenemase-producing K. pneumoniae. Our study provides a better understanding of antibiotic resistance threat and enables physicians to select the most appropriate antibiotics.

Predominance of Acinetobacter spp., Harboring the blaIMP Gene, Contaminating the Hospital Environment in a Tertiary Hospital in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study

“…About one-third and nearly two-thirds of the GNB showing resistance to meropenem had positive phenotypes by MHT and CDT or DDST, respectively. Similar findings were reported elsewhere, that MHT has low sensitivity and specificity rates, failing to detect MBLs producing GNB [24] and also that the high proportion of MBLs detection by CDT and DDST may be due to the good dissemination and predominance of genes encoding for MBLs locally and globally [14,[25][26][27].…”

Molecular detection of ESBL- and carbapenemase-producing Klebsiella pneumoniae isolates in southwest Iran

“…These ndings are in agreement with Gurung et al report from Nepal [20]. Nevertheless, the frequency of carbapenemase production in this study was lower than in previous reports from India at 58.2% [31], Iran 43.3% [32], Malaysia 71.4% [33], and Nepal 51.1% [34]. Genotypic analysis in the current study revealed that the frequent gene among carbapenemase-producing isolates was bla OXA−48 (36.8%), but only 15.8% and 5.3% harbored the bla NDM and bla IMP genes, respectively.…”

Antimicrobial susceptibility pattern and phenotypic detection of metallo-beta lactamases in K. pneumoniae isolates in a tertiary care hospital

“…The prevalence correlates to great extent with the studies by Nirwati et al, Gill et al, Farkhanda et al, Sodhi et al, Sonia et al and Odari et al who reported prevalence to be 17.36%, 22.43%, 15.18%, 21.23%, 23.73% and 15.7% respectively [17][18][19][20][21][22]. However, Pyakurel et al reported prevalence 31.4% which is higher than the present study 23. Maximum isolates of K. pneumoniae were obtained from urine (30.24%), followed by ET tubes/ET secretions (27.82%), other respiratory samples (13.30%), blood (12.90%) pus and wound swabs (11.29%) and minimum from body fluids (4.43%).…”

“…Gupta et al, Pyakurel et al and Su et al have reported isolation rate of K. pneumoniae 70%, 55.1% and 20.6% from ICU samples respectively. 23,29,31 In the present study the pattern of resistance shown by K. pneumoniae towards various antimicrobials was reported as following amoxicillin/clavulanic acid (90.7%), imipenem (78.3%), meropenem (78.7%), ceftiaxone (95.5%), ciprofloxacin (89.6%), amoxicillin/clavulanic acid (90.7%), cotrimoxazole (85.1%), however isolates were highly sensitive to colistin (95.6%) followed by amikacin (76.7%) and tigecycline (63.7%). 31,[39][40][41] Hoang et al had reported 95% MBL production in K. pneumoniae isolates, which is quite higher as compared to this study.…”